Psychiatric medications, science, marketing, psychiatry in general, and occasionally clinical psychology. Questioning the role of key opinion leaders and the use of "science" to promote commercial ends rather than the needs of people with mental health concerns.

Friday, June 19, 2009

In a recent speech, incoming American Psychiatric Association president Alan Schatzberg was quoted as saying:

"As the recent attacks on APA and leaders of the profession have occurred, it has struck me that some of the detractors in the press have voiced concern that some folks have earned too good a living, often by doing presentations," he said. "I have heard from colleagues and directly from one reporter asking me about one of my colleagues having too high an annual income. I can assure you these detractors would not ask the same question of a surgeon or radiologist earning 10 times the amount paid our colleagues. None of us do what we do for money. Yet, it is also time for us to realize that our members and residents have never taken vows of poverty, and the complexity of the work deserves to be recognized. We need to ask ourselves how we have contributed to our own devaluation with which others seem to resonate, and we need to reverse the course. The rewards for our dedication should not be limited to a sense of pride, but we are also entitled to be paid commensurate to the challenge.

So Schatzberg must be diving into dumpsters, begging at interstate off-ramps, and the like. Oh, wait a minute. This is the same Alan Schatzberg who in 2007 owned close to 5 million shares of Corcept (which translates into roughly 5 million dollars). I have no idea how many shares he owns currently. Corcept, in case you missed it, has shown its drug mifepristone (aka RU-486: "The Abortion Pill") is ineffective in relieving depression among patients with psychotic depression. Schatzberg, at one time, was the chief scientific officer of Corcept and was also the cofounder of the company. According to Corcept's website, he is still a scientific advisor. Despite the stuides of mifepristone showing negative results, the results were spun in a manner to make them sound as if they were positive (1, 2, 3, 4). In a press release, Schatzberg was quoted as saying that mifepristone "may be the equivalent of shock treatments in a pill." Right, with all of the negative studies, it's definitely shock treatment, meditation, and running a marathon all wrapped together in a capsule. Should he be paid "commensutate to the challenge" of trying to weave positive findings from negative results? I don't know what role, if any, he played in the misleading publications surrounding mifepristone. But in his role as chief of the scientific advisory board, I'd venture a guess that he had some involvement. But worry not, the negative results were not spun into positive findings for the sake of money, but for an altruistic love of patients with depression. I'm touched.

Schatzberg was also busted by yours truly putting his name on a duplicate publication that pimped Cymbalta, Lilly's antidepressant. The study presented data from the same set of patients who were involved in a previously published Cymbalta study. Scientific results are not meant to be published in nearly identical form in two different journals. But that didn't stop Schatzberg and his coauthors. If you've not read the lengthy post on this topic, please feel free to check it out in order to understand my cynicism regarding his recent speech.

Another quote from his talk:

We need to sit down with industry and come up with ways of interacting that are acceptable to both sides and fit with future guidelines. I have pledged to follow up on recent initiatives and work with Dr. Scully [APA's medical director] and our Board of Trustees to effect a new partnership—a partnership we can be proud of for what it contributes to the well-being of our patients and our profession.

I can only wonder what type of mutually agreeable interactions would meet Schatzberg's standards. Duplicate publication, serving as a scientific advisor for a company that writes scientifically dubious papers? And it appears that he's encouraging psychiatrists to be greedy -- take the money and don't feel bad about it. Taking industry money is perfectly acceptable in some instances, but it needs to be transparent, and there are plentiful examples of academics getting paid by industry and slanting science in a sponsor-friendly way.

And the clincher:

"The time has come," he said, "to be proud of what we do and to advocate for what we and our patients justly deserve."

Right, psychiatrists deserve to make as much money as possible bending science for corporate sponsors -- and they should be proud of it too. Am I being too cynical? Maybe. But when a guy with Schatzberg's record starts talking about psychiatrists needing to rake in more money from industry, it makes me think I'm living in Bizarro World. Get ready, APA memebers; it's going to be an interesting ride.

16 comments:

Anonymous
said...

Schatzberg has a tin ear for the ethical issues. The money isn’t the issue. The issue is what people like Schatzberg and Nemeroff do to get the money, and the examples they set for students and junior faculty.

Your example of Schatzberg pimping Lilly’s drug in a duplicate publication is a classic exposé. Don’t forget, this pos was published in Schatzberg’s own journal!

Up front disclaimer: this is not going to be a nice comment, so if you as a reader are looking for fair and reasonable dialogue, look elsewhere!

Schatzberg is the final example of what is not just wrong with the APA, but with the entrenched seasoned members who are beyond out of touch with what is responsible and appropriate as physicians in 2009. As a psychiatrist, but NOT a member of this pathetic organization, I call for noting it is time for nonAPA members to step up and denounce this farce of an organization to be minimized and disregarded, if we as a collective want to save psychiatry. These old fucks who think they know better than those of us who have become psychiatrists in the past 10 to 15 years need to retire or die off! They are a ruthless, insensitive, patriarchial bunch who only serve the antipsychiatry crowd by their poor choices in their unidimensional approach with meds only options. And Schatzberg is their poster child now.

Sometimes you have to call people for what they are, and being politically correct is just a waste of time. The "old Guard" are not guarding, just hoarding and rationalizing their greed and lack of compassion. Don't believe me, just watch the lame justifications this guy will spew for the next year of his presidency of the APA.

Thank you for missing the entire point of the post. I am not suggesting that anyone work for free. Rather, I'm concerned with people doing bad science, then getting reimbursed generously by corporate sponsors for their poor scientific work. I don't like unpaid bad science, but the paid bad science makes me even more ticked off -- as it suggests an element of greed rather than simple human error. Or maybe it's just blind faith in one's corporate sponsors. I can't claim to know the motivation with any certainty, but regardless of motivation, I don't think that anyone should take pride in doing bad science. And Schatz has been guilty of doing some bad science which favors his corporate sponsors. Which is not cool in my book.

Certainly, doing bad science and taking pride in it is a bad thing. However, just how clear is the line between speculation and genuine bad science? The way things are in the psychiatric field, what's accepted as right one moment could be completely debunked by the next study published.

There are many ways to control chronic pain, and one of them is through anxiolytics, which are medicines that have obtained a better result than other drugs such as naproxen, aspirin, ibuprofen, medications that relieve pain but are not effective for these chronic cases, as these pains are more like a back pain that the world is one of the most common causes of absenteeism in findrxonline as indicated in your article on back pain and chronic pain, and opioid medications are as Vicodin, Lorcet, Meperidine to soothe the pain caused by this disease and we must be very careful.

The APA has no credibility. It acts like a criminal organization, protecting misogynistic, narcissistic, sometimes mentally ill, Jewish white men, like Paul S. Appelbaum and all of his Harvard buddies. They cover up crimes like sexual assaults and manslaughter, destroy other people's careers and feel free to publish ridiculously long lists of articles and research studies that have absolutely no impact on our abusive, inadequate, dangerous health care system. Medicine in this country is a game and the APA boys are some of the best gamesters around. How else could Appelbaum, who is clearly suffering from, and severely affected by, Asperger's disorder, be tolerated and given so much power for so long.

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About Me

I'm an academic with a respectable amount of clinical experience and no drug industry funding. Given my lack of time, don't expect multiple daily updates. Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts, and you'll probably pick up on these pet peeves before long...